Tissue fixation system

ABSTRACT

A tissue fixation system is provided for dynamic and rigid fixation of tissue. A fastener connected with an elongate fastening member, such as a cable, wire, suture, rod, or tube, is moved through a passage between opposite sides of tissue. The fastener is provided with a groove that accommodates at least a portion of the fastening member to reduce the profile during the movement through the passage. The fastener is then pivoted to change its orientation. A second fastener can then be connected with the fastening member. While tension is maintained in the fastening member, the fasteners are secured against relative movement. This may be done by deforming the fastening member, either the first or second fasteners, or a bushing placed against the second fastener.

CROSS-REFERENCE TO RELATED APPLICATION

This Application claims the benefit of U.S. Provisional Patent Application No. 60/655,140, filed Feb. 22, 2005, entitled TISSUE FIXATION SYSTEM AND METHOD, the content of which is incorporated by reference in its entirety.

FIELD OF THE INVENTION

The invention relates to a system and method for fixation and stabilization of tissue. In particular, the invention relates to minimally invasive bone fracture fixation and stabilization.

BACKGROUND OF THE INVENTION

It is well-known in the medical arts that applying pressure to tissue helps during the healing process. Incised or torn soft tissue, for example, may be approximated with bandages, sutures, or staples. Proper and more rapid healing of broken or fractured bones likewise may be facilitated by applying constant pressure to the bone. For instance, physicians may insert pins, screws, or bolts in the area of the fracture in order to apply pressure to the fracture.

However, inserting screws through or around fractures can be complex and time-consuming. For example, the process of inserting a screw typically involves multiple steps conducted from multiple incisions or openings that provide access to the treated bone or tissue, including the steps of drilling holes, measuring the relevant distances to determine the appropriate screw selection, tapping the hole to establish threads, and screwing the screw into the hole.

In addition to the length and complexity of the process, bone screws also may lose their grip and strip out of the bone. In addition, currently available lag screws also typically provide only one side of cortex fixation and are generally not suited for percutaneous surgery. Moreover, when placing the screws in the bone, the physician may not accurately set the screw into the distal hole or may miss the distal hole completely, thereby resulting in the screw stripping the threads or breaking the bone.

Many devices and instruments have been disclosed to fasten soft and hard tissue for enhanced healing or tissue reconstruction. Examples of such devices include bone plates, bone wraps, external bone supports, and the like.

For example, U.S. Pat. No. 5,921,986, the contents of which are incorporated herein by reference, discloses a bone suture and associated methods for implantation and fracture fixation. The '986 Patent describes fasteners and anchors used in conjunction with an elongate fixation element, such as a suture. In some cases, it may be advantageous to use more rigid fixation elements.

Accordingly, a need exists for a tissue fixation instrument which can provide flexible or rigid fixation of tissue while accessing the tissue from a small skin portal.

SUMMARY OF THE INVENTION

The present invention relates to a tissue fixation system. The system comprises an elongate fastening member and a fastener moveable with respect to the elongate fastening member from a first orientation to a second orientation, the fastener having a body with a tissue contacting surface that includes a groove configured and dimensioned to receive a portion of the elongate member in the first orientation. The system can also include a second fastener or other means for maintaining tension in the elongate fastening member.

A biasing means can be provided to maintain the fastener in the first orientation. The biasing means can be an adhesive between the groove and the portion of the elongate fastening member received in the groove. The biasing means could also be a frangible connection between the groove and the portion of the elongate fastening member received in the groove.

The fastener body can have a free surface opposite the tissue contacting surface, with the free surface including a channel configured and dimensioned to receive a portion of the elongate member in the first orientation. The fastener body can also include a through bore extending from the tissue contacting surface through the free surface.

In one embodiment, the fastener body includes leading and trailing ends. The leading end can be tapered or otherwise shaped to facilitate insertion. The groove terminates at the through bore and extends toward one of the leading and trailing ends and the channel terminates at the through bore and extends toward the other of the leading and trailing ends. In an exemplary embodiment, the groove extends toward the leading end and the channel extends toward the trailing end.

The free surface of the fastener body can be provided with a well surrounding the through bore. The well can be configured and dimensioned to receive at least a portion of the stop. A distal end of the elongate fastening member can include a stop larger than the through bore.

The present invention also relates to a medical instrument or device for securing the fastener with respect to the elongate fastening member. The medical device tensions the elongate fastening member and crimps either the fastener or a bushing. Another aspect of the invention relates to methods of tissue fixation using the disclosed tissue fixation systems.

BRIEF DESCRIPTION OF THE DRAWINGS

A more complete understanding of the present invention, and the attendant advantages and features thereof, will be more readily understood by reference to the following detailed description when considered in conjunction with the accompanying drawings wherein:

FIG. 1 shows a schematic illustration of a tissue fixation system according to the present invention utilized for fracture fixation;

FIG. 2 shows a perspective view of a fastener according to the present invention;

FIG. 3 shows a side view of the fastener of FIG. 2;

FIG. 4 shows a bottom view of the fastener of FIG. 2;

FIG. 5 shows a top view of the fastener of FIG. 2;

FIG. 6 shows a fastener and elongate fastening member with the fastener in a first orientation with respect to the elongate fastening member;

FIG. 7 shows a front view of a fastener in the first orientation with respect to the elongate fastening member with the fastener rotated 180° compared to FIG. 6;

FIG. 8 shows a back view of the fastener and elongate fastening member of FIG. 7;

FIG. 9A shows an elongate fastening member according to the present invention;

FIG. 9B shows an elongate fastening member including expandable members;

FIG. 10 shows a fastener in a second orientation with respect to an elongate fastening member;

FIG. 11 shows a cannulated drill system used to create a passage through the tissue to be fixed;

FIG. 12 shows a sleeve having a lumen through which the fixation system can be passed;

FIG. 13 shows a distal fastener being inserted into the sleeve;

FIG. 14 shows a pushrod used to move the distal fastener through the sleeve;

FIG. 15 shows the distal fastener in the second orientation;

FIG. 16 shows a proximal fastener being used to maintain the tension in the elongate fastening member;

FIG. 17 depicts a front isometric view of the medical device of the present invention;

FIG. 18 depicts a rear partial isometric view showing the tensioning mechanism of the medical device of FIG. 17;

FIG. 19 depicts a rear isometric view showing the tensioning mechanism of the medical device of FIG. 17;

FIG. 20 depicts an isometric view of the crimping mechanism collett of the medical device of FIG. 17;

FIG. 21 depicts a partial isometric view showing the handle portion of the crimping mechanism of the medical device of FIG. 17;

FIG. 22 depicts a top sectional view of the crimping mechanism collett closer of the medical device of FIG. 17;

FIG. 23 depicts a partial isometric view showing the cutting mechanism of the medical device of FIG. 17;

FIG. 24 depicts a partial isometric view showing the collett portion of the cutting mechanism of FIG. 23;

FIG. 25 depicts an isometric view showing the cutting arm of the cutting mechanism of FIG. 24;

FIG. 26 depicts the medical device of FIG. 17 in use to secure a bone fracture;

FIG. 27 depicts a front isometric view of an alternative medical device of the present invention;

FIG. 28 depicts an isometric view of the crimping mechanism collett of the medical device of FIG. 27;

FIG. 29 depicts an isometric view of the crimping mechanism collett closer of the medical device of FIG. 27;

FIG. 30 depicts a sectional view of the medical device of FIG. 27 in use to secure a bone fracture;

FIG. 31 depicts an exemplary fastener for use with the medical device of FIG. 27;

FIG. 32 depicts an alternative sectional view of the medical device of FIG. 27 in use to secure a bone fracture;

FIG. 33 depicts an alternative fastener for use with the medical device of FIG. 32;

FIG. 34 depicts an alternative cable tensioner for the medical device of FIG. 17;

FIG. 35 depicts a sectional view of the cable tensioner of FIG. 34;

FIG. 36 depicts a front isometric view of the medical device of the present invention;

FIG. 37 depicts a side sectional view showing the tensioning mechanism of the medical device of FIG. 36;

FIG. 38 depicts a rear exploded view showing the tensioning mechanism of the medical device of FIG. 36;

FIG. 39 depicts an isometric view of the crimping mechanism collett of the medical device of FIG. 36;

FIG. 40 depicts a partial isometric view showing the handle portion of the crimping mechanism of the medical device of FIG. 36;

FIG. 41 depicts a partial isometric view showing the cutting mechanism of the medical device of FIG. 36;

FIG. 42 depicts an isometric view of the cutting mechanism in the collett of the medical device of FIG. 36;

FIG. 43 depicts the cutting wedge of the medical device of FIG. 36; and

FIG. 44 depicts a safety lock of the medical device of FIG. 36.

DETAILED DESCRIPTION OF THE INVENTION

The present invention provides a tissue fixation system for dynamic and rigid fixation of tissue. The system can be utilized for the fixation and stabilization of body tissue, including soft tissue to soft tissue, soft tissue to bone, and bone to bone. The surgical system can additionally be used to affix implants and grafts to body tissue. The system can access and treat fractured, incised or torn tissue, or the like, from one access area (i.e., from only one opening to the tissue to be fastened) instead of requiring two or more openings. That is, the system is a linear fixation system that can be used with a single, small incision or portal in the skin or other soft tissue to gain access to the fractured bone. The fixation system may be an all-in-one system, packaged as a system kit, for creating a passage in tissue, positioning fasteners, and tensioning an elongate fastening member, like a suture, thread, cable, wire, rod, or pin. The individual components of the system can either be reusable or single use components.

Referring now to the drawing figures in which like reference designators refer to like elements, FIG. 1 shows an exemplary embodiment of a tissue fixation system 100 according to the present invention. A fractured portion 102 of a bone 104 is approximated by system 100. Use of system 100 is not limited to any particular type of fracture. Furthermore, use of system 100 is not limited to fracture fixation. In other words, system 100 can be utilized for other tissue fixation applications (such as soft tissue) or similar clinical indications. Examples of such tissue includes, are not limited to, muscle, cartilage, ligament, tendon, skin, etc. Also, the tissue may be stomach tissue, and the system may be used during bariatric surgery, like stomach stapling. Additionally, the system 100 can be used for the fixation of implants to tissue.

In this regard, the present invention may be used in conjunction with any surgical procedure of the body. The repair, reconstruction, augmentation, and securing of tissue or an implant may be performed in connection with surgery of a joint, bone, muscle, ligament, tendon, cartilage, capsule, organ, skin, nerve, vessel, or other body part. For example, tissue may be repaired, reconstructed, augmented, and secured following intervertebral disc surgery, knee surgery, hip surgery, organ transplant surgery, bariatric surgery, spinal surgery, anterior cruciate ligament (ACL) surgery, tendon-ligament surgery, rotator cuff surgery, capsule repair surgery, fractured bone surgery, pelvic fracture surgery, avulsion fragment surgery, hernia repair surgery, and surgery of an intrasubstance ligament tear, annulus fibrosis, fascia lata, flexor tendons, etc. In one particular application, an anastomosis is performed over a balloon and the methods and devices of the present invention are used to repair the vessel.

Also, tissue may be repaired after an implant has been inserted within the body. Such implant insertion procedures include, but are not limited to, partial or total knee replacement surgery, hip replacement surgery, bone fixation surgery, etc. The implant may be an organ, partial organ grafts, tissue graft material (autogenic, allogenic, xenogenic, or synthetic), collagen, a malleable implant like a sponge, mesh, bag/sac/pouch, collagen, or gelatin, or a rigid implant made of metal, polymer, composite, or ceramic. Other implants include breast implants, biodegradable plates, porcine or bovine patches, metallic fasteners, compliant bearing for medial compartment of the knee, nucleus pulposus prosthetic, stent, tissue graft, tissue scaffold, biodegradable collagen scaffold, and polymeric or other biocompatible scaffold. The scaffold may include fetal cells, stem cells, embryonal cells, enzymes, and proteins.

The present invention further provides flexible and rigid fixation of tissue. Both rigid and flexible fixation of tissue and/or an implant provides compression to enhance the healing process of the tissue. A fractured bone, for example, requires the bone to be realigned and rigidly stabilized over a period time for proper healing. Also, bones may be flexibly secured to provide flexible stabilization between two or more bones. Soft tissue, like muscles, ligaments, tendons, skin, etc., may be flexibly or rigidly fastened for proper healing. Flexible fixation and compression of tissue may function as a temporary strut to allow motion as the tissue heals. Furthermore, joints which include hard and soft tissue may require both rigid and flexible fixation to enhance healing and stabilize the range of motion of the joint. Flexible fixation and compression of tissue near a joint may provide motion in one or more desired planes. The fasteners described herein and incorporated by reference provide for both rigid and flexible fixation.

Although the invention is described primarily on a macroscopic level, it is also envisioned that the present invention can be used for microscopic applications. For example, in the repair of nerve tissue, individual cells or fibers may need to be repaired. Similarly, muscle repair may require tightening of individual muscle fibers.

System 100 includes a distal fastener 106 contacting fracture portion 102, a proximal fastener 108 contacting bone 104, and an elongate fastening member 110 extending through the fracture and coupling distal and proximal fasteners 106, 108. Tension is maintained in elongate fastening member 110 to press fasteners 106, 108 against opposite sides of bone 104 with a desired force. This force presses fracture portion 102 against bone 104 firmly together to promote healing of the fracture. If desired, buttons or other force distributing members could be provided between fasteners 106, 108 and the bone. Although FIG. 1 shows distal and proximal fasteners 106, 108 as having the same construction, they could have differing construction. However, for convenience and practical purposes, it may be beneficial if distal and proximal fasteners 106 and 108 have substantially the same construction.

FIGS. 2-5 show an exemplary embodiment of a fastener 112 that can be used as part of system 100, i.e. as either or both of distal and proximal fasteners 106, 108. Fastener 112 has a body 114 that is configured and dimensioned to facilitate implantation through minimally invasive procedures, e.g. through a cannula or sleeve. In particular, body 114 includes a tissue contacting surface 116 that is provided with groove 118 that receives a portion of elongate fastening member 110 when fastener 112 is in a first orientation with respect to elongate fastening member 110. This is seen in FIG. 6. The accommodation of elongate fastening member 110 within groove 118 helps to minimize the profile of the assembly of fastener 112 and elongate fastening member 110. The reduced profile can be more readily passed through a cannula or sleeve. If desired, an adhesive can be provided within groove 118 to bias fastener 112 in the first orientation. Alternatively, a frangible connection can be provided between groove 118 and the portion of elongate fastening member 110. This frangible connection keeps fastener 112 in the first orientation with respect to elongate fastening member 110 until it is broken.

Fastener 112 is provided with first and second ends 120, 122. As shown in FIG. 6, first end 120 is the leading end and second end 122 is the trailing end. In this position, when fastener 112 is pivoted to a second orientation, like distal fastener 106 of FIG. 1, tissue contacting surface 116 is in contact with the tissue. As shown in FIGS. 7 and 8, second end 122 is the leading end and first end 120 is the trailing end. In this position, when fastener 112 is pivoted to the second orientation, like proximal fastener 108 of FIG. 1, tissue contacting surface 116 is in contact with the tissue.

Fastener body 114 has a free surface 124 opposite tissue contacting surface 116. Free surface 124 is provided with a channel 126 that receives a portion of elongate fastening member 110 when fastener 112 is in a first orientation with respect to elongate fastening member 110. As shown in FIGS. 7 and 8, fastener 112 is being slid along elongate fastening member 110. In particular, a through bore 128 extends from tissue contacting surface 116 through free surface 124. Through bore 128 is larger in diameter than elongate fastening member 110 so that fastener 112 freely slides along elongate fastening member 110. A portion of elongate fastening member 110 fits within channel 126 on free surface 124 and a portion of elongate fastening member 110 fits within groove 118 on tissue contacting surface 116.

Fastener body 114 is shown with first end 120 having a substantially flat profile and second end 122 having a tapered profile. In general, any suitable external configuration can be used for fastener 112. Examples of fasteners may be found in U.S. Pat. Nos. 5,163,960; 5,403,348; 5,464,426; 5,549,630; 5,593,425; 5,713,921; 5,718,717; 5,782,862; 5,814,072; 5,814,073; 5,845,645; 5,921,986; 5,948,002; 6,010,525; 6,045,551; 6,159,234; 6,368,343; 6,447,516; 6,475,230; 6,592,609; 6,635,073; and 6,719,765. Other fastener types are disclosed in U.S. patent application Ser. Nos. 10/102,413; 10/228,855; 10/779,978; 10/780,444; and 10/797,685. The above cited patents and patent applications are hereby incorporated by reference.

Fastener 112 can be made of any biocompatible material suitable for a given application. For example, the fasteners may be, but are not limited to, degradable, biodegradable, bioerodible, bioabsorbable, mechanically expandable, hydrophilic, bendable, deformable, malleable, riveting, threaded, toggling, barbed, bubbled, laminated, coated, blocking, pneumatic, one-piece, multi-component, solid, hollow, polygon-shaped, pointed, self-introducing, and combinations thereof. Also, the fasteners may include metallic material, polymeric material, ceramic material, composite material, body tissue, synthetic tissue, hydrophilic material, expandable material, compressible material, heat bondable material, and combinations thereof. Examples of body tissue include bone, collagen, cartilage, ligaments, or tissue graft material like xenograft, allograft, and autograft. The fasteners may also be made from a porous matrix or mesh of biocompatible and bioresorbable fibers acting as a scaffold to regenerate tissue.

The fasteners may further be made of or have a coating made of an expandable material. The material could be compressed then allowed to expand. Alternatively, the material could be hydrophilic and expand when it comes in contact with liquid. Examples of such expandable materials are ePTFE and desiccated body tissue.

Moreover, the fasteners described herein and incorporated by reference may include therapeutic substances to promote healing. These substances could include antibiotics, hydroxyapatite, anti-inflammatory agents, steroids, antibiotics, analgesic agents, chemotherapeutic agents, bone morphogenetic protein (BMP), demineralized bone matrix, collagen, growth factors, autogenetic bone marrow, progenitor cells, calcium sulfate, immo suppressants, fibrin, osteoinductive materials, apatite compositions, germicides, fetal cells, stem cells, enzymes, proteins, hormones, cell therapy substances, gene therapy substances, and combinations thereof. These therapeutic substances may be combined with the materials used to make the fasteners to produce a composite fastener. Alternatively, the therapeutic substances may be impregnated or coated on the fastener. Time-released therapeutic substances and drugs may also be incorporated into or coated on the surface of the fastener. The therapeutic substances may also be placed in a bioabsorbable, degradable, or biodegradable polymer layer or layers.

FIG. 9A shows an exemplary embodiment of an elongate fastening member 130. Elongate fastening member 130 includes a body 132 and has a stop 134 at a distal end. Body 132 can be selected for a given application. For example, if a rigid elongate fastening member 130 is needed, body 132 can be a rod or a tube. If a more flexible elongate fastening member 130 is needed, body 132 can be a suture. In general, a wire analogous to those used for cerclage of bone fractures is believed to provide a suitable combination of strength and flexibility. Although body 132 is shown as a single strand wire, the invention can be used with any type of surgical cable, such as a multi-strand cable.

Stop 134 can be made integral with body 132 or separate and then attached. Stop 134 is larger in diameter than through bore 128 in body 114 of fastener 112. Thus, once stop 134 reaches through bore 128, fastener 112 cannot be slid any further along elongate fastening member 130. As shown in FIG. 5, free surface 124 of fastener 112 is provided with a well 136 surrounding through bore 128. Well 136 is configured and dimensioned to receive at least a portion of stop 134. As shown in FIG. 10, this helps reduce the profile of the assembly when fastener 112 is in a second orientation with respect to elongate fastening member 130.

Referring to FIG. 9B, in another embodiment, the elongated fastener member 130 includes expandable members 131, positioned along the body 132. Upon insertion into the tissue, the expandable members 131 expand to engage the surrounding tissue. For examples, the expandable members 131 can be barbs. The barbs 131 engage the surrounding tissue, maintaining the elongated fastener member's 130 position within the tissue.

The elongate fastening members of the present invention may be made of metallic material, non-metallic material, composite material, ceramic material, polymeric material, co polymeric material, or combinations thereof. The members may be degradable, biodegradable, bioabsorbable, or nonbiodegradable. Examples of suture materials that can be used for the elongate fastening members are polyethylene, polyester, cat gut, silk, nylon, polypropylene, linen, cotton, and copolymers of glycolic and lactic acid. Preferably, the members are flexible or bendable. They may be threadlike, monofilament, multifilament, braided, or interlaced. The members may have a coating of therapeutic substances or drugs. For example, the members may include antibiotics, hydroxyapatite, anti-inflammatory agents, steroids, antibiotics, analgesic agents, chemotherapeutic agents, bone morphogenetic protein, demineralized bone matrix, collagen, growth factors, autogenetic bone marrow, progenitor cells, calcium sulfate, immo suppressants, fibrin, osteoinductive materials, apatite compositions, fetal cells, stem cells, enzymes, proteins, hormones, and germicides.

The use of the tissue fixation system according to the present invention will now be described using fracture fixation as an example. If necessary, the fracture is reduced bringing fracture portion 102 into contact with bone 104 (FIG. 11). The reduction can be achieved using any number of techniques.

As also shown in FIG. 11, a drill system 138 is used to drill across the fracture, thereby creating a passage completely through bone 104. Drill system 138 includes a drill bit 140 with a headpiece configured for attachment to a drill. A drill stop can be placed on the headpiece and prevents drill bit 140 from penetrating too far beyond the tissue to be drilled. Drill system 138 may be a cannulated drill system that fits over a k-wire or other similar guide wire. A cannula or sleeve 142 may encircle drill bit 140 or at least the shaft portion of drill bit 140. As drill bit 140 creates a passage through bone 104, sleeve 142 is positioned in the passage. Drill system 138 is used to create a passage in bone 104 from the proximal side of bone 104 to the distal side of bone 104, then the drill and drill bit 140 are removed from sleeve 142 (FIG. 12).

As shown in FIG. 13, a distal fastener 112 a is inserted into sleeve 142. Distal fastener 112 a is inserted in the first orientation with respect to elongate fastening member 130 with first end 120 as the leading end. In this configuration, tissue contacting surface 116 will be in contact with fracture portion 102 when distal fastener 112 a is pivoted into the second orientation. This is best seen in FIGS. 14 and 15, in which a pushrod 144 is used to advance distal fastener 112 a and elongate fastening member 130 through sleeve 142. Pushrod 144 also facilitates the pivoting of distal fastener 112 a from the first orientation to the second orientation. This pivoting is not possible until distal fastener 112 a has exited through sleeve 142. Also, since the length of distal fastener 112 a is larger than the passage created in bone 104, pulling back on elongate fastening member 130 helps to ensure distal fastener 112 a is in the second orientation and flush against fracture portion 102.

As illustrated in FIG. 16, sleeve 142 is removed from bone 104. Fastener 112 a is located on the distal side of bone 104. Elongate fastening member 130 extends from fastener 112 a through the bone passage and out the proximal opening of the bone or tissue passage. Any suitable means can be used to keep distal fastener 112 a against fracture portion 102 with tension, where the tension can be measure and controlled in accordance with use. For example, elongate fastening member 130 can be deformed at the proximal end of the passage such that the deformed section rests against bone 104. The deformation would depend on the nature of elongate fastening member 130. If elongate fastening member 130 is a relatively flexible element, such as a suture, cable, or wire, then simply tying a knot in fastening member 130 could be sufficient to maintain the tension. If elongate fastening member 130 does not allow a knot, such as would be the case with a rod or tube, then mechanical deformation of elongate fastening member 130 to create an enlarged head could be sufficient to maintain the tension. U.S. Patent Application Publication No. US 2002/0016593, the contents of which are incorporated herein by reference, discloses mechanisms to mechanically deform an extension member and could be used to deform elongate fastening member 130.

Alternatively, the elongated fastening member 130 can be deformed by an energy, such as thermal energy, to deform elongate fastening member 130 to create an enlarged head sufficient to maintain the tension.

In an exemplary embodiment, a proximal fastener 112 b is used to secure distal fastener 112 a and elongate fastening member 130. In this embodiment, proximal fastener 112 b is identical to distal fastener 112 a. If not already pre-loaded, proximal fastener 112 b is loaded onto elongate fastening member 130. Proximal fastener 112 b is loaded as shown in FIGS. 7 and 8, i.e. with second end 122 as the leading end so that after proximal fastener 112 b is slid down against bone 104 and pivoted into the second orientation, tissue contacting surface 116 is in contact with bone 104.

Elongate fastening member 130 is tensioned, and proximal fastener 112 b is secured to elongate fastening member 130 to thereby approximate the fracture and stabilize bone 104. The tension of elongate fastening member 130 pulls on distal and proximal fasteners 112 a, 112 b generally toward each other, thereby applying pressure to the fractured bone or tissue. In this regard, a bushing 146 can be used to secure proximal fastener 112 b with the desired tension. Single or multiple elongated members 130 can be used to secure the fractured bone or tissue.

Although a number of mechanisms can be used to secure bushing 146, an instrument or medical device particularly useful for this will now be described.

In this regard, the present invention also provides a medical device for securing a fastener against relative movement with respect to a cable. As previously disclosed, a cable and pair of oppositely spaced fasteners can be used to secure a bone facture. The cable is passed through the bone and fracture; a first fastener secures the cable on a first side (fracture side) of the bone; and a second fastener is positioned about the cable on a second side of the bone, opposite the first fastener. A bushing is positioned onto the cable to secure the second fastener against the second side of the bone. A force is applied to the bushing, compressing the second fastener against the second side of the bone and providing a tension to the cable. The tension in the cable can be measured and controlled, for example, with the used of a sensor and spring element. The spring can apply the force to tension the cable, and the sensor can be used to measure the resulting tension. Alternatively, the sensor can measure the compression of the tissue to determine the tension. The bushing is crimped about the cable, securing the second fastener against the second side of the bone, such that a tension is provided through the cable between the first and second fasteners.

Referring to FIG. 17, a medical device 200 is provided for securing the bushing to the cable. The medical device 200 includes a handle portion 202 having a tensioning mechanism 204, tensioning the cable and applying a force to the bushing, and a crimping mechanism 206 for securing the bushing to the cable.

Referring also to FIGS. 18 and 19, the tensioning mechanism 204 includes a collett holder 208 defining a longitudinal passage along a central longitudinal axis A. The collett holder 208 is affixedly positioned through a top portion 212 of the handle portion 202 with collett holder pin 214. A cable tensioner 216 is slidably positioned on a first end 218 of the collett holder 208. The cable tensioner 216 defines a cable passage longitudinally aligned with the longitudinal passage of the collett holder 208. An end portion 222 of the cable tensioner 216 includes a cable aperture 224 for threading the cable there through. A radial groove 226 and circumferential groove 228 are provided on the end portion 222 of the cable tensioner 216, such that the cable can be wrapped about the circumferential groove 228 of the cable tensioner 216, thereby preventing relative movement between the cable and the cable tensioner 216.

A cable tension lever 230 is pivotally connected to the cable tensioner 216 with a lever pin 232. The cable tension lever 230 is adjustably positioned on the handle portion 202 with body pins 234, wherein a body pin 234 is mirrorly positioned on opposite sides of the handle portion 202. The body pins 234 are engaged in the cable tension lever 230 arcuate lever slots 236, such that cable tension lever 230 and cable tensioner 216 are movably connected to the handle portion 202.

In use, as the cable tension lever 230 is pivoted about the cable tensioner 216 from a first lever position L1 to a second lever position L2, the body pins 234 traverse the arcuate lever slots 236, resulting in a translation of the cable tensioner 216 along the first end 218 of the collett holder 208 from a first tensioner position T1 to a second tensioner position T2. A tension bias member 238 is interposed between the cable tensioner 216 and the handle portion 202, biasing the cable tensioner 216 into the first tensioner position T1. The cable tension lever 230 includes tension indicating markings 240 along each of the arcuate lever slots 236. The tension markings 240 indicate the tension to be applied to the cable.

Referring also to FIG. 34 an alternative cable tensioner 440 is provided. Cable tensioner 440 is slidably positioned on a first end 218 of the collett holder 208. The cable tensioner 440 defines a cable passage longitudinally aligned with the longitudinal passage of the collett holder 208. An end portion 442 of the cable tensioner 440 includes a cleat 444 and a cleat stop 446. The cleat 444 is pivotally mounted to the cable tensioner 440, including a bias member 448 biasing the cleat 444 into a closed position. A cable 450 is threadable between the cleat 446 and the cleat stop 448, where in the closed position the cleat 446 imparts a force onto the cable 450, securing the cable 450 in the cable tensioner 440.

The bias member 448 biases the cleat 444 such that in the closed position the cable can be further drawn through the cable tensioner 440, for example, to position the fastener proximal to the tissue while removing any initial slack from the cable 450. However, the cleat 444 prevents the cable 450 from being drawn back through the cable tensioner 440. For example, the cleat 444 can include an arcuate contact surface 452 such that the force imparted on the cable 450 in the closed position increases as the tension on the cable 450 increases, preventing the cable 450 from being drawn back through the cable tensioner 440. The cleat arcuate surface 452 can further include a plurality of teeth 454, which can be utilized to grip cable 450.

Referring to FIGS. 18 and 20, a collett 242 is affixed to a second end portion 244 of the collett holder 208, opposite the cable tensioner 216. The collett 242 defines a collett passage longitudinally aligned with the longitudinal passage of the collett holder 208 along the central longitudinal axis A. An end portion of the collett 242 is bisected, forming first and second collett arms 248 and 250. A gap portion 252 is provided between the first and second collett arms 248 and 250. Each of the first and second collett arms 248 and 250 includes force application end portions 254 and 256. The force application end portions 254 and 256 combine to form a bushing aperture 258 configured to received the bushing therein. The collett 242 is made of a semi-rigid material, such that the first and second collett arms 248 and 250 can be moved from an open to a closed position, closing the gap 252 between the force application end portions 254 and 256.

In use, the tensioning mechanism 204 is used to tension the cable. The cable can include a single or multiple filaments. The cable is inserted through the medical device 200 along the central longitudinal axis A, through the collett 242, collett holder 208, and the cable tensioner 216, positioning the bushing in the bushing aperture 258 and extending the cable through the cable aperture 224. To tension the cable, the cable tension lever 230 is actuated from the first lever position L1 to the second lever position L2, sliding the cable tensioner 216 along the collett holder 208 from the first tensioner position T1, into the handle portion 202 against the tension bias member 238, to the second tensioner position T2. The cable is positioned through the radial groove 226 and wrapped about the circumferential groove 228 on the end portion 222 of the cable tensioner 216, securing the cable to the cable tensioner 216. The cable tension lever 230 is released, such that tension bias member 238 biases the cable tensioner 216 from the second tensioner position T2 towards the first tensioner position T1. The movement of the cable tensioner 216 towards the first tensioner position T1 applies a tension to the cable, forcing the bushing into the second fastener. The applied tension can be selected by actuating the cable tension lever 230 to the desired tension marking 240.

Referring again to FIGS. 17 and 21, the crimping mechanism 206 includes an outer tube 260 slidingly positioned over the collett holder 208. The outer tube 260 includes a first end 262 operably connected to a trigger 264 and a second end 266 connected to a collett closer 268. The trigger 264 is pivotally mounted in the handle portion 202, such that the trigger 264 can be actuated from a first trigger position TR1 to a second trigger position TR2. A locking mechanism 265 prevents the trigger 264 from being actuated. The locking mechanism 265 is rotated to disengage the trigger 264, allowing actuation of the trigger 264.

The operable connection between the first end of the outer tube 262 and the trigger 264 includes an outer tube ferrule 270 slidably positioned about the collett holder 208 and affixed to the first end of the outer tube 262. A tube bias member 272 is interposed between the handle portion 202 and the outer tube ferrule 270, such that the tube bias member 272 biases the outer tube ferrule 270 and the outer tube 260 into a first tube position P1. A pair of crimp cams 274 are pivotally connected to the handle portion 202 on opposite sides of the trigger 264. The crimp cams 274 each include first edges 276 having an arcuate section 278 for engaging the outer tube ferrule 270, where the crimp cams 274 are translatable with respect to the handle portion 202 from a first cam position C1 to a second cam position C2.

An actuation of the trigger 264 from a first trigger position TR1 to a second trigger position TR2 translated the crimp cams 274 with respect to the handle portion from a first cam position C1 to a second cam position C2 position. The arcuate sections 278 of the crimp cams 274 engage the outer tube ferrule 270, translating the outer tube ferrule 270 and the outer tube 260 along the collett holder 208 from the first tube position P1 to a second tube position P2. As the trigger 264 is released, the tube bias member 272 biases the outer tube ferrule 270 and the outer tube 260 from the second tube position P2 to the first tube position P1. Simultaneously, the crimp cams 274 and the trigger 264 are moved to the first cam position C1 and the first trigger position TR1.

Referring to FIGS. 17 and 22, the collett closer 268 is positioned on the outer tube 260 proximal to the force application end portions 254 and 256 of the first and second collett arms 248 and 250. As the outer tube 260 is moved from the first tube position P1 to the second tube position P2, the collett closer 268 is moved over the force application end portions 254 and 256. The collett closer 268 includes inner tapered surfaces 280, such that the inner tapered surfaces 280 apply compressive forces to the force application end portions 254 and 256 as the collett closer 268 is moved over the force application end portions 254 and 256, closing the gap 252 there between.

In use, the trigger 264 is actuated from the first trigger position TR1 to the second trigger position TR2. The actuation of the trigger 264 slides the outer tube 260 along the collett holder 208 from the first tube position P1 to the second tube position P2, moving collett closer 268 about the force application end portions 254 and 256 of the first and second collett arms 248 and 250. The inner tapered surfaces 280 of the collett closer 268 apply compressive forces to the first and second force application end portions 254 and 256, closing the gap 252 there between. The trigger 264 is released, allowing the tube bias member 272 to bias the outer tube 260 from the second tube position P2 to the first tube position P1, moving the collett closer 268 from the force application end portions 254 and 256.

Referring to FIGS. 23-25, the crimping mechanism 206 can further include a cutting mechanism. The cutting mechanism includes a cut off cam 284 slidingly positioned along a bottom portion of the collett holder 208. The cut off cam 284 includes a first end portion 286 positioned through the outer tube ferrule 270. A cut off cam ring 288 is slidably positioned about the collett holder 208, engaging the first end portion 286 of the cut off cam 284. The cut off cam ring 288 is positioned proximal to the trigger 264, such that as the trigger 264 is actuated from the first trigger 264 position TR1 to the second trigger 264 position TR2, a top portion 290 of the trigger 264 engages the cut off cam ring 288, sliding the cut off cam ring 288 and cut off cam 284 along the collett holder 208. A cut off bias member 291 is interposed between the outer tube ferrule 270 and the cut off cam ring 288.

A cut off arm 292 is connected to the collett 242, at least partially positioned in the gap 252 between the first and second collett arms 248 and 250. The cut off arm 292 includes a cutting head portion 294 positioned proximal to the first and second force application end portions 254 and 256, at least partially positioned in the gap 252, interposed between the first and second collett arms 248 and 250. The cutting head portion 294 includes a cutting edge 296, for cutting the cable, and a lower angular surface 298 for engagement by a second end portion 300 of the cut off cam 284.

In use, the trigger 264 is actuation from the first trigger position TR1 to the second trigger position TR2. The actuation of the trigger 264 results in the top portion 290 of the trigger 264 engaging the cut off cam ring 288, sliding the cut off cam ring 288 and cut off cam 284 along the collett holder 208. The second end portion 300 of the cut off cam 284 engages the angular surface 298 of the cutting head 294, forcing the cutting edge 296 into the cable, cutting the cable. The trigger 264 is released, allowing the cut off bias member 291 to bias the cut off cam 284 from the cutting head 294.

Referring to FIG. 26, in a method of use, the cable is passed through the bone and fracture, where a first fastener secures the cable on a first side (fracture side) of the bone and a second fastener is positioned about the cable on a second side of the bone, opposite the first fastener. A bushing is positioned onto the cable to secure the second fastener against the second side of the bone.

The cable is inserted through the medical device 200 along the central longitudinal axis “A”, through the collett 242, collett holder 208, and the cable tensioner 216, positioning the bushing in the bushing aperture 258 and extending the cable through the cable aperture 224. To tension the cable, the cable tension lever 230 is actuated from the first lever position L1 to the second lever position L2, sliding the cable tensioner 216 along the collett holder 208 from the first tensioner position T1, into the handle portion 202 against the tension bias member 238, to the second tensioner position T2. The cable is positioned through the radial groove 226 and wrapped about the circumferential groove 228 on the end portion 222 of the cable tensioner 216, securing the cable to the cable tensioner 216. The cable tension lever 230 is released, such that tension bias member 238 biases the cable tensioner 216 from the second tensioner position T2 towards the first tensioner position T1. The movement of the cable tensioner 216 towards the first tensioner position T1 applies a tension to the cable, pressing the bushing against the second fastener. The applied tension can be selected by actuating the cable tension lever 230 to the desired tension marking 240.

The trigger 264 is actuated from the first trigger position TR1 to the second trigger position TR2. The actuation of the trigger 264 slides the outer tube 260 along the collett holder 208 from the first tube position P1 to the second tube position P2, moving collett closer 268 about the force application end portions 254 and 256 of the first and second collett arms 248 and 250. The inner tapered surfaces 280 of the collett closer 268 apply compressive forces to the first and second force application end portions 254 and 256, compressing the first and second force application end portions 254 and 256 about the bushing positioned in the bushing aperture 258. The compressive forces crimp the bushing about the cable, securing the bushing to the cable.

Simultaneously, the actuation of the trigger 264 results in the top portion 290 of the trigger 264 engaging the cut off cam ring 288, sliding the cut off cam ring 288 and cut off cam 284 along the collett holder 208. The second end portion 300 of the cut off cam 284 engages the angular surface 298 of the cutting head 294, forcing the cutting edge 296 into the cable, cutting the cable.

In another embodiment a medical device 320 of the present invention secures a fastener against relative movement with respect to a suture, with the fastener itself being deformed. Medical device 320 is substantially similar to medical device 200 and like reference number shall be used to indicate like items.

Referring to FIGS. 27 and 28, medical device 320 includes collett 322. As with collett 242, previously disclosed and illustrated, collett 322 is affixed to the second end portion 244 of the collett holder 208, opposite the cable tensioner 216. The collett 322 defines a collett passage longitudinally aligned with the longitudinal passage of the collett holder 208, along the central longitudinal axis A. An end portion of the collett 322 is bisected, forming first and second collett arms 324 and 326. A gap portion 328 is provided between the first and second collett arm 324 and 326. Each of the first and second collett arms 324 and 326 includes force application end portions 330 and 332. The force application end portions 330 and 332 combine to form a fastener aperture 334 configured to receive the fastener therein. The force application end portions 330 and 332 each include opposing compressive members 336 for compressing the fastener about the suture.

Referring to FIG. 27 and 29, medical device 320 includes collett closer 340. The collett closer 340 is positioned on the outer tube 260 proximal to the force application end portions 330 and 332 of the first and second collett arms 324 and 326. The collett closer 340 includes slotted sections 342 configured for receiving end portions of the fastener therein. As the outer tube 260 is moved from the first tube position P1 to the second tube position P2, the collett closer is moved over the force application end portions 330 and 332. Similar to collett closer 268, the collett closer 340 includes inner tapered surfaces 280 (See FIG. 22), such that the inner tapered surfaces 280 apply compressive forces to the force application end portions 330 and 332 as the collett closer 340 is moved over the force application end portions 330 and 332, closing the gap 328 there between.

Referring to FIGS. 30 and 31, in a method of use suture 360 is inserted through the bone 362 and fracture 364, where the suture 360 is threaded through a fastener 366 on a first side (fracture side) of the bone 362. The suture 360 is reinserted through the fracture 364 and bone 362, such that first and second ends 368 and 370 of the suture 360 extend from the bone 362. The first and second ends of the suture 368 and 370 are threaded through a fastener 372, where the first end of the suture 368 is threaded through a first aperture 374 in the fastener 372 and the second end of the suture 370 is threaded through a second aperture 376 in the fastener 372.

Referring also to FIG. 26, the ends of the suture 368 and 370 are inserted through the medical device 320 along the central longitudinal axis A, through the collett 322, collett holder 208, and the cable tensioner 216, positioning the fastener 372 in the fastener aperture 334 and extending the ends of the suture 368 and 370 through the cable aperture 224. To tension the suture 360, the cable tension lever 230 is actuated from the first lever position L1 to the second lever position L2, sliding the cable tensioner 216 along the collett holder 208 from the first tensioner position T1, into the handle portion 202 against the tension bias member 238, to the second tensioner position T2. The suture ends 368 and 370 are positioned through the radial groove 226 and wrapped about the circumferential groove 228 on the end portion 222 of the cable tensioner 216, securing the suture 360 to the cable tensioner 216. The cable tension lever 230 is released, such that tension bias member 238 biases the cable tensioner 216 from the second tensioner position T2 towards the first tensioner position T1. The movement of the cable tensioner 216 towards the first tensioner position T1 applies tension to the suture 360, compressing the fastener 372 against the bone 362. The applied tension can be selected by actuating the cable tension lever 230 to the desired tension marking 240.

The trigger 264 is actuation from the first trigger position TR1 to the second trigger position TR2. The actuation of the trigger 264 slides the outer tube 260 along the collett holder 208 from the first tube position P1 to the second tube position P2, moving collett closer 340 about the force application end portions 330 and 332 of the first and second collett arms 324 and 326. The inner tapered surfaces 280 of the collett closer 340 apply compressive forces to the first and second force application end portions 330 and 332, compressing compressive members 336 of the first and second force application end portions 330 and 332 into the first and second fastener apertures 374 and 376. The compressive forces crimp the first and second fastener apertures 374 and 376 about the suture ends 368 and 370, securing the fastener 372 to the suture ends 368 and 370.

Simultaneously, the actuation of the trigger 264 results in the top portion 290 of the trigger 264 engaging the cut off cam ring 288, sliding the cut off cam ring 288 and cut off cam 284 along the collett holder 208. The second end portion 200 of the cut off cam 283 engages the angular surface 298 of the cutting head 294, forcing the cutting edge 296 into the suture ends 268 and 270, cutting the suture ends 368 and 370.

Referring to FIG. 32, similar to FIGS. 18 and 20, a collett 400 is affixed to a second end portion 244 of the collett holder 208, opposite the cable tensioner 216. The collett 400 defines a collett passage longitudinally aligned with the longitudinal passage of the collett holder 208 along the central longitudinal axis A. An end portion of the collett 400 is bisected, forming first and second collett arms 402 and 404. A gap portion 406 is provided between the first and second collett arms 402 and 404. Each of the first and second collett arms 402 and 404 includes force application end portions 408 and 410. The force application end portions 408 and 410 combine to form a bushing aperture 412 configured to received the bushing therein 414. The collett 400 is made of a semi-rigid material, such that the first and second collett arms 402 and 404 can be moved from an open to a closed position, closing the gap 406 between the force application end portions 408 and 410.

Referring also to FIG. 33, in a method of use, suture 416 is inserted through the bone 418 and fracture 420, where the suture 416 is threaded through a fastener 422 on a first side (fracture side) of the bone 424. The suture 416 is reinserted through the fracture 420 and bone 418, such that first and second ends 426 and 428 of the suture 416 extend from the bone 418. The first and second ends of the suture 426 and 428 are threaded through a fastener 414, where the first and second ends 426 and 428 of the suture 416 is threaded through an aperture 430 in the fastener 414.

Referring also to FIGS. 26 and 29, the ends of the suture 426 and 428 are inserted through the medical device 320 along the central longitudinal axis A, through the collett 400, collett holder 208, and the cable tensioner 216, positioning the fastener 414 in the fastener aperture 412 and extending the ends of the suture 426 and 428 through the cable aperture 224. To tension the suture 416, the cable tension lever 230 is actuated from the first lever position L1 to the second lever position L2, sliding the cable tensioner 216 along the collett holder 208 from the first tensioner position T1, into the handle portion 202 against the tension bias member 238, to the second tensioner position T2. The suture ends 426 and 428 are positioned through the radial groove 226 and wrapped about the circumferential groove 228 on the end portion 222 of the cable tensioner 216, securing the suture 360 to the cable tensioner 216. The cable tension lever 230 is released, such that tension bias member 238 biases the cable tensioner 216 from the second tensioner position T2 towards the first tensioner position T1. The movement of the cable tensioner 216 towards the first tensioner position T1 applies tension to the suture 416, compressing the fastener 414 against the bone 418. The applied tension can be selected by actuating the cable tension lever 230 to the desired tension marking 240.

The trigger 264 is actuated from the first trigger position TR1 to the second trigger position TR2. The actuation of the trigger 264 slides the outer tube 260 along the collett holder 208 from the first tube position P1 to the second tube position P2, moving collett closer 340 about the force application end portions 408 and 410 of the first and second collett arms 402 and 404. The inner tapered surfaces 280 of the collett closer 340 apply compressive forces to the first and second force application end portions 408 and 410. The compressive forces crimp the aperture 430 about the suture ends 426 and 428, securing the fastener 414 to the suture ends 426 and 428.

Referring to FIG. 36, a medical device 500 is provided for securing the bushing to the cable. The medical device 500 includes a handle portion 502 having a tensioning mechanism 504, tensioning the cable and applying a force to the bushing, and a crimping mechanism 506 for securing the bushing to the cable.

Referring also to FIGS. 37 and 38, the tensioning mechanism 504 includes a collett holder 508 defining a longitudinal passage along a central longitudinal axis A. The collett holder 508 is affixedly positioned through a top portion 510 of the handle portion 502. A cable tensioner 512 is slidably positioned on a first end 514 of the collett holder 508. The cable tensioner 512 defines a cable passage longitudinally aligned with the longitudinal passage of the collett holder 508. An end portion 516 of the cable tensioner 512 includes a cable aperture for threading the cable there through. A radial groove and circumferential groove 518 are provided on the end portion 516 of the cable tensioner 512, such that the cable can be wrapped about the circumferential groove 518 of the cable tensioner 512, thereby preventing relative movement between the cable and the cable tensioner 512.

In an exemplary embodiment, the cable tensioner 512 can include a retention bushing 520 and a tension insert 522. The tension insert 522 defines a cable passage longitudinally aligned with the longitudinal passage of the cable tensioner 512. The retention bushing 520 is positioned about a portion of the tension insert 522, where an end portion 524 is threaded into the end portion 516 of the cable tensioner 512. An opposite end portion 526 of the tension insert 522 includes a cable aperture 528 for threading the cable there through. A radial groove 530 is provided on the end portion 526 of the cable tensioner 512 and the retention bushing 520 and the tension insert 522 combine to form a circumferential groove 532, such that the cable can be wrapped about the circumferential groove 532, thereby preventing relative movement between the cable and the cable tensioner 512.

A cable tension lever 534 is pivotally connected to the cable tensioner 512 with a lever pin 536. The cable tension lever 534 is adjustably positioned on the handle portion 502 with body pins 538, wherein a body pin 538 is mirrorly positioned on opposite sides of the handle portion 502. The body pins 538 are engaged in the cable tension lever 536 arcuate lever slots 540, such that cable tension lever 534 and cable tensioner 512 are movably connected to the handle portion 502.

In use, as the cable tension lever 534 is pivoted about the cable tensioner 512 from a first lever position L1 to a second lever position L2, the body pins 538 traverse the arcuate lever slots 540, resulting in a translation of the cable tensioner 512 along the first end 514 of the collett holder 508 from a first tensioner position T1 to a second tensioner position T2. A tension bias member 542 is interposed between the cable tensioner 512 and the handle portion 502, biasing the cable tensioner 512 into the first tensioner position T1.

Referring to FIGS. 37 and 39, a collett 544 is affixed to a second end portion 546 of the collett holder 508, opposite the cable tensioner 512. The collett 544 defines a collett passage longitudinally aligned with the longitudinal passage of the collett holder 508 along the central longitudinal axis A. An end portion of the collett 544 is bisected, forming first and second collett arms 548 and 550. A gap portion 552 is provided between the first and second collett arms 548 and 550. Each of the first and second collett arms 548 and 550 includes force application end portions 554 and 556. The force application end portions 554 and 556 combine to form a bushing aperture 558 configured to received the bushing therein. The collett 544 is made of a semi-rigid material, such that the first and second collett arms 548 and 550 can be moved from an open to a closed position, closing the gap 552 between the force application end portions 554 and 556.

In use, the tensioning mechanism 504 is used to tension the cable. The cable can include single or multiple filaments. The cable is inserted through the medical device 500 along the central longitudinal axis A, through the collett 544, collett holder 508, and the cable tensioner 512, positioning the bushing in the bushing aperture 558 and extending the cable through the cable aperture 530. To tension the cable, the cable tension lever 354 is actuated from the first lever position L1 to the second lever position L2, sliding the cable tensioner 512 along the collett holder 508 from the first tensioner position T1, into the handle portion 502 against the tension bias member 542, to the second tensioner position T2. The cable is positioned through the radial groove 528 and wrapped about the circumferential groove 532 on the between the retention bushing 520 and the tension insert 522, securing the cable to the cable tensioner 512. The cable tension lever 534 is released, such that tension bias member 542 biases the cable tensioner 512 from the second tensioner position T2 towards the first tensioner position T1. The movement of the cable tensioner 512 towards the first tensioner position T1 applies a tension to the cable, forcing the bushing into the second fastener. The applied tension can be selected by actuating the cable tension lever 534 to the desired tension.

Referring to FIGS. 36 and 40, the crimping mechanism 506 includes an outer tube 560 slidingly positioned over the collett holder 508. The outer tube 560 includes a first end 562 operably connected to a trigger 564 and a second end 566 connected to a collett closer 568. The trigger 264 is pivotally mounted in the handle portion 502, such that the trigger 564 can be actuated from a first trigger position TR1 to a second trigger position TR2. A locking mechanism 570 prevents the trigger 564 from being actuated. The locking mechanism 570 is disengaged by rotating it away from the handle, where the locking mechanism is secured to the trigger with the locking pawl 572. (See also FIG. 37).

The operable connection between the first end of the outer tube 562 and the trigger 564 includes an outer tube ferrule 574 slidably positioned about the collett holder 408 and affixed to the first end of the outer tube 562. A tube bias member 576 is interposed between the handle portion 502 and the outer tube ferrule 574, such that the tube bias member 576 biases the outer tube ferrule 574 and the outer tube 560 into a first tube position P1. A tube washer 578 can be provided between the tube ferrule 574 and the bias member 576.

An actuation of the trigger 564 from a first trigger position TR1 to a second trigger position TR2 translates the outer tube ferrule 574 along the collett holder 208 from the first tube position P1 to a second tube position P2. In the second tube position P2 a tube pawl 580 engages the outer tube ferrule 574, hold the outer tube ferrule in the second tub position P2.

Referring to FIGS. 36 and 42, the collett closer 568 is positioned on the outer tube 560 proximal to the force application end portions 554 and 556 of the first and second collett arms 548 and 550. As the outer tube 560 is moved from the first tube position P1 to the second tube position P2, the collett closer 568 is moved over the force application end portions 554 and 556. The collett closer 568 includes inner tapered surfaces 582, such that the inner tapered surfaces 580 apply compressive forces to the force application end portions 554 and 556 as the collett closer 568 is moved over the force application end portions 554 and 556, closing the gap 552 there between.

In use, the trigger 564 is actuated from the first trigger position TR1 to the second trigger position TR2. The actuation of the trigger 564 slides the outer tube 560 along the collett holder 508 from the first tube position P1 to the second tube position P2, moving collett closer 568 about the force application end portions 554 and 556 of the first and second collett arms 548 and 550. The inner tapered surfaces 580 of the collett closer 568 apply compressive forces to the first and second force application end portions 554 and 556, closing the gap 552 there between.

Referring to FIGS. 41-43, the crimping mechanism 506 can further include a cutting mechanism. The cutting mechanism includes a pair of cut off cams 582 and 584 positioned in the collett gap 552. A pair of wedges 586 and 588 are slidingly positioned along and on opposite sides of the collett 550 and the collett holder 508. Each of the wedges 586 and 588 include tapered ends 590 and 592 positioned proximal to the cut off arms, such that when the wedges are moved from a first wedge position W1 to a second wedge position W2, the tapered ends 590 and 592 compress the cut off cams 582 and 584 together, cutting the cable.

The handle 502 further includes a wedge pusher 594 slidingly positioned about the collett holder 508, adjacent to second ends 594 and 596 of wedges 586 and 588. The wedge pusher 594 is slidable from a first position to a second position, such that the wedges 586 and 588 are moved from the first wedge position W1 to the second wedge position W2. A rocker 596 is pivotally connected to the handle 502, such that an actuation of the rocker 596 from a first rocker position R1 to a second rocker position R2, slides the wedge pusher 594 from the first position to the second position, moving wedges 586 and 588 from the first wedge position W1 to the second wedge position W2

Referring to FIGS. 41 and 44, the locking mechanism 570 includes a rocker kicker 598 pivotally affixed therein. The rocker kicker 598 is biasedly connected to the locking mechanism 570, being held in a closed position by a pin 600. When the trigger 564 is actuated from the first trigger position TR1 to the second trigger position TR2, the release 602 engages the pin 600, releasing the rocker kicker 590.

The trigger 564 is released, allowing the trigger 564 to move from the second trigger position TR2 to the first trigger position TR1. To actuate the cutting mechanism, the trigger is again moved from the first trigger position TR1 to the second trigger position TR2, such that the rocker kicker 598 engages the rocker 596, pivoting the rocker 596 from the first rocker position R1 to the second rocker position. The rocker 596 slides the wedge pusher 594 from the first position to the second position, moving wedges 586 and 588 from the first wedge position W1 to the second wedge position W2, such that, the tapered ends 590 and 592 compress the cut off cams 582 and 584 together, cutting the cable. The trigger 564 can then be released, releasing the crimped fastener.

It is also contemplated that the system and medical device of the present invention may be disposable or may be sterilized after use and reused.

The methods and devices of the present invention may be used in conjunction with any surgical procedure of the body. The repair, reconstruction, augmentation, and securing of tissue or an implant may be performed in connection with surgery of a joint, bone, muscle, ligament, tendon, cartilage, capsule, organ, skin, nerve, vessel, or other body part. For example, tissue may be repaired, reconstructed, augmented, and secured following intervertebral disc surgery, knee surgery, hip surgery, organ transplant surgery, bariatric surgery, spinal surgery, anterior cruciate ligament (ACL) surgery, tendon-ligament surgery, rotator cuff surgery, capsule repair surgery, fractured bone surgery, pelvic fracture surgery, avulsion fragment surgery, hernia repair surgery, and surgery of an intrasubstance ligament tear, annulus fibrosis, fascia lata, flexor tendons, etc. In one particular application, an anastomosis is performed over a balloon and the methods and devices of the present invention are used to repair the vessel.

Also, tissue may be repaired after an implant has been inserted within the body. Such implant insertion procedures include, but are not limited to, partial or total knee replacement surgery, hip replacement surgery, bone fixation surgery, etc. The implant may be an organ, partial organ grafts, tissue graft material (autogenic, allogenic, xenogenic, or synthetic), collagen, a malleable implant like a sponge, mesh, bag/sac/pouch, collagen, or gelatin, or a rigid implant made of metal, polymer, composite, or ceramic. Other implants include biodegradable plates, porcine or bovine patches, metallic fasteners, compliant bearings for one or more compartments of the knee, nucleus pulposus prosthetic, stent, tissue graft, tissue scaffold, biodegradable collagen scaffold, and polymeric or other biocompatible scaffold. The scaffold may include fetal cells, stem cells, embryonal cells, enzymes, and proteins.

The present invention further provides flexible and rigid fixation of tissue. Both rigid and flexible fixation of tissue and/or an implant provides compression to enhance the healing process of the tissue. A fractured bone, for example, requires the bone to be realigned and rigidly stabilized over a period time for proper healing. Also, bones may be flexibly secured to provide flexible stabilization between two or more bones. Soft tissue, like muscles, ligaments, tendons, skin, etc., may be flexibly or rigidly fastened for proper healing. Flexible fixation and compression of tissue may function as a temporary strut to allow motion as the tissue heals. Furthermore, joints which include hard and soft tissue may require both rigid and flexible fixation to enhance healing and stabilize the range of motion of the joint. Flexible fixation and compression of tissue near a joint may provide motion in one or more desired planes. The fasteners described herein and incorporated by reference provide for both rigid and flexible fixation.

It is contemplated that the devices and methods of the present invention be applied using minimally invasive incisions and techniques to preserve muscles, tendons, ligaments, bones, nerves, and blood vessels. A small incision(s) may be made adjacent the damaged tissue area to be repaired, and a tube, delivery catheter, sheath, cannula, or expandable cannula may be used to perform the methods of the present invention. U.S. Pat. No. 5,320,611 entitled, Expandable Cannula Having Longitudinal Wire and Method of Use, discloses cannulas for surgical and medical use expandable along their entire lengths. The cannulas are inserted through tissue when in an unexpanded condition and with a small diameter. The cannulas are then expanded radially outwardly to give a full-size instrument passage. Expansion of the cannulas occurs against the viscoelastic resistance of the surrounding tissue. The expandable cannulas do not require a full depth incision, or at most require only a needle-size entrance opening.

Also, U.S. Pat. Nos. 5,674,240; 5,961,499; and 6,338,730 disclose cannulas for surgical and medical use expandable along their entire lengths. The cannula has a pointed end portion and includes wires having cores which are enclosed by jackets. The jackets are integrally formed as one piece with a sheath of the cannula. The cannula may be expanded by inserting members or by fluid pressure. The cannula is advantageously utilized to expand a vessel, such as a blood vessel. An expandable chamber may be provided at the distal end of the cannula. The above mentioned patents are hereby incorporated by reference.

In addition to using a cannula with the methods of the present invention, an introducer may be utilized to position fasteners at a specific location within the body. U.S. Pat. No. 5,948,002 entitled Apparatus and Method for Use in Positioning a Suture Anchor, discloses devices for controlling the placement depth of a fastener. Also, U.S. patent application Ser. No. 10/102,413 discloses methods of securing body tissue with a robotic mechanism. The above-mentioned patent and application are hereby incorporated by reference. Another introducer or cannula which may be used with the present invention is the VersaStep® System by Tyco® Healthcare.

The present invention may also be utilized with minimally invasive surgery techniques disclosed in U.S. patent application Ser. No. 10/191,751 and U.S. Pat. Nos. 6,702,821 and 6,770,078. These patent documents disclose, inter alia, apparatus and methods for minimally invasive joint replacement. The femoral, tibial, and/or patellar components of a knee replacement may be fastened or locked to each other and to adjacent tissue using fasteners disclosed herein and incorporated by reference. Furthermore, the methods and devices of the present invention may be utilized for repairing, reconstructing, augmenting, and securing tissue or implants during and “on the way out” of a knee replacement procedure. For example, the anterior cruciate ligament and other ligaments may be repaired or reconstructed; quadriceps mechanisms and other muscles may be repaired. The patent documents mentioned above are hereby incorporated by reference.

In addition, intramedullary fracture fixation and comminuted fracture fixation may be achieved with the devices and methods of the present invention. For example, a plate or rod may be positioned within or against the fractured bone. A fastener may be driven through or about the bone and locked onto the plate, rod, or another fastener.

It is further contemplated that the present invention may be used in conjunction with the devices and methods disclosed in U.S. Pat. No. 5,329,846 entitled, Tissue Press and System, and U.S. Pat. No. 5,269,785 entitled, Apparatus and Method for Tissue Removal. For example, an implant secured within the body using the present invention may include tissue harvested, configured, and implanted as described in the patents. The above-mentioned patents are hereby incorporated by reference.

Furthermore, it is contemplated that the methods of the present invention may be performed under indirect visualization, such as endoscopic guidance, computer assisted navigation, magnetic resonance imaging, CT scan, ultrasound, fluoroscopy, X-ray, or other suitable visualization technique. The implants, fasteners, fastener assemblies, and sutures of the present invention may include a radiopaque material for enhancing indirect visualization. The use of these visualization means along with minimally invasive surgery techniques permits physicians to accurately and rapidly repair, reconstruct, augment, and secure tissue or an implant within the body. U.S. Pat. Nos. 5,329,924; 5,349,956; and 5,542,423 disclose apparatus and methods for use in medical imaging. Also, the present invention may be performed using robotics, such as haptic arms or similar apparatus. The above-mentioned patents are hereby incorporated by reference.

All references cited herein are expressly incorporated by reference in their entirety.

It will be appreciated by persons skilled in the art that the present invention is not limited to what has been particularly shown and described herein above. In addition, unless mention was made above to the contrary, it should be noted that all of the accompanying drawings are not to scale. A variety of modifications and variations are possible in light of the above teachings without departing from the scope and spirit of the invention. Therefore, it will be understood that the appended claims are intended to cover all such modifications and embodiments which come within the spirit and scope of the present invention. 

What is claimed is:
 1. A tissue fixation system comprising: an elongate flexible member; and a fastener configured for implantation in the body, the fastener configured to be positionable on the flexible member and movable from a first orientation to a second orientation without disconnecting from the flexible member, the fastener having a body with a first surface and a tapered portion defined by a leading end surface and the first surface and a second surface parallel to the first surface and defined between the leading end surface and a trailing end surface, the first surface including a substantially flat portion configured to be positionable against a tissue section, and the fastener body including a bore extending from the first surface to the second surface and configured to receive a portion of the flexible member at an angle with respect to the flat portion, wherein said flat portion is positionable against the tissue section in the second orientation by tensioning the flexible member.
 2. The tissue fixation system of claim 1 wherein the second surface includes a channel configured to receive a portion of the flexible member in the first orientation.
 3. The tissue fixation system of claim 1 wherein the fastener body includes a groove configured to receive a portion of the flexible member to reduce a profile of the fastener in at least the first or second orientation.
 4. The tissue fixation system of claim 3 wherein the groove extends toward the leading end surface.
 5. The tissue fixation system of claim 3 further comprising a biasing means for maintaining the fastener in the first orientation.
 6. The tissue fixation system of claim 5 wherein the biasing means comprises an adhesive between a groove on the first surface and the portion of the flexible member received in the groove.
 7. The tissue fixation system of claim 5 wherein the biasing means comprises a frangible connection between a groove on the first surface and the portion of the flexible member received in the groove.
 8. The tissue fixation system of claim 1 wherein the fastener includes a taper.
 9. The tissue fixation system of claim 1 wherein the second surface of the fastener body includes a well surrounding the bore.
 10. The tissue fixation system of claim 1 wherein a distal end of the flexible member includes a stop larger than the bore.
 11. The tissue fixation system of claim 10 wherein the well is configured and dimensioned to receive at least a portion of the stop.
 12. The tissue fixation system as set forth in claim 1 further comprising a second fastener that includes a first surface having a substantially flat portion configured to be positionable adjacent the second tissue section and a bore extending from the first surface through a second surface.
 13. The tissue fixation system of claim 1 wherein the fastener is pivotable from the first orientation to the second orientation and the first surface is configured to contact a tissue section in the second orientation.
 14. The tissue fixation system of claim 1 wherein the first and second surfaces are substantially parallel.
 15. The tissue fixation system of claim 1 wherein the bore is substantially perpendicular to the first or second surface.
 16. The tissue fixation system of claim 1 wherein the fastener includes at least a deformable portion.
 17. The tissue fixation system of claim 1 wherein the fastener includes at least a rounded portion.
 18. The tissue fixation system of claim 1 wherein the leading or trailing end surface of the fastener is narrower than a majority of the fastener body.
 19. A tissue fixation system to secure a first tissue section relative to a second tissue section, comprising: an flexible member positionable in at least a portion of the first and second tissue sections; a first fastener configured for implantation in the body, the first fastener configured to be movable from a first orientation to a second orientation and positionable on the flexible member, the first fastener having a body with a first surface and a tapered portion defined by a leading end surface and the first surface and a second surface parallel to the first surface and defined between the leading end surface and a trailing end surface, the first surface including a substantially flat portion configured to be positionable adjacent the first tissue section, and the first fastener body including a bore extending from the first surface to the second surface and configured to receive a portion of the flexible member at an angle with respect to the flat portion, wherein a first end of the flexible member includes a stop larger than the bore; and a second fastener configured for implantation in the body, the second fastener configured to be positionable on the flexible member at a distance from the first fastener and adjacent to the second tissue section, wherein the flexible member is tensionable between the first and second fasteners.
 20. The tissue fixation system of claim 19 wherein the first fastener is an anchor.
 21. A tissue fixation system as set forth in claim 19 wherein the first fastener is moveable with respect to the flexible member from a first orientation to a second orientation without disconnecting from the flexible member.
 22. The tissue fixation system as set forth in claim 21 further comprising a biasing means maintaining the first fastener in the first orientation.
 23. The tissue fixation system as set forth in claim 22 wherein the biasing means comprises an adhesive between a groove on the first surface and the portion of the flexible member received in the groove.
 24. The tissue fixation system as set forth in claim 22 wherein the biasing means comprises a frangible connection between a groove on the first surface and the portion of the flexible member received in the groove.
 25. The tissue fixation system as set forth in claim 21 further comprising a bushing member positionable on the second end of the flexible member, adjacent to the second fastener, wherein the bushing member is affixable about the second end of the flexible member.
 26. The tissue fixation system as set forth in claim 21 wherein the first fastener is pivoted from a first orientation to a second orientation in which the first surface contacts the first tissue section and the second fastener is pivoted from a first orientation to a second orientation and the first surface is configured to contact the second tissue section.
 27. The tissue fixation system as set forth in claim 19 wherein the first fastener body includes a channel.
 28. The tissue fixation system as set forth in claim 27 wherein the second surface of the first fastener body includes a well surrounding the bore.
 29. The tissue fixation system as set forth in claim 28 wherein the first fastener is an anchor.
 30. The tissue fixation system as set forth in claim 29 wherein the well is configured and dimensioned to receive at least a portion of the stop.
 31. The tissue fixation system as set forth in claim 30 wherein the first fastener body includes a taper.
 32. The tissue fixation system as set forth in claim 19 wherein the leading or trailing end surface includes an edge.
 33. The tissue fixation system as set forth in claim 19 wherein the first surface includes a groove.
 34. The tissue fixation system as set forth in claim 19 wherein the second fastener includes a first surface having a substantially flat portion configured to be positionable adjacent the second tissue section and a bore extending from the first surface through a second surface.
 35. The tissue fixation system as set forth in claim 19 wherein the second fastener has a body with a first surface that includes a groove configured and dimensioned to receive a portion of the flexible member in a first orientation and a second surface opposite the first surface that includes a channel configured and dimensioned to receive a portion of the flexible member in the first orientation.
 36. The tissue fixation system of claim 19 wherein the first and second surfaces are substantially parallel.
 37. The tissue fixation system of claim 19 wherein the bore is substantially perpendicular to the first or second surface.
 38. The tissue fixation system of claim 19 wherein the first or second fastener includes at least a deformable portion.
 39. The tissue fixation system of claim 19 wherein the fastener includes at least a rounded portion.
 40. The tissue fixation system of claim 19 wherein the leading or trailing end surface of the first fastener is narrower than a majority of the first fastener body.
 41. A tissue fixation system comprising: an elongate flexible member; a fastener configured for implantation in the body, the fastener configured to be positionable on the flexible member and movable from a first orientation to a second orientation with respect to the flexible member, the fastener having a body with a first surface and a tapered portion defined by a leading end surface and the first surface, a second surface parallel to the first surface and defined by the leading end surface and a trailing end surface, and a longitudinal axis between the leading and trailing end surfaces, the first surface including a substantially flat portion configured to be positionable against a tissue section, and the fastener body including a bore extending between the first and second surfaces at an angle with respect to the longitudinal axis.
 42. The tissue fixation system of claim 41 wherein the fastener includes a groove configured to reduce a profile of the fastener in the first orientation.
 43. The tissue fixation system of claim 41 wherein the fastener is an anchor.
 44. The tissue fixation system of claim 41 wherein the first and second surfaces are substantially parallel.
 45. The tissue fixation system of claim 41 wherein the bore is substantially perpendicular to the first or second surface.
 46. The tissue fixation system of claim 41 wherein the fastener includes at least a deformable portion.
 47. The tissue fixation system of claim 41 wherein the leading or trailing end surface of the fastener is rounded.
 48. The tissue fixation system of claim 41 wherein the leading or trailing end surface of the fastener is narrower than a majority of the fastener body. 